Investigation of abdominal masses
Physical signs of abdominal masses
Signs of hepatomegaly
- Mass descending below right costal margin and costal angle
- Moves with respiration and can not get above it
- Dullness to percussion up to the level of the 8th rib in the mid-axillary line
Signs of splenomegaly
- Mass descending below the left 10th rib and enlarging in a line towards the umbilicus
- Often has a palpable notch on the medial border
- Moves with respiration and can not get above it
- Dullness to percussion
- Can be brought forward by lifting the lower ribs
- Can not be felt bimanually or balloted
Signs of a renal mass
- Mass lies in paracolic gutter
- Moves with respiration but usually only lower border is palpable
- Can be felt bimanually or balloted
- Not dull to percussion
Signs of an enlarged gallbladder
- Mass arising from below the tip of the right 9th rib
- Smooth and hemi-ovoid in shape
- Moves with respiration
- Dull to percussion
- Can not feel space between mass and liver
Signs of an enlarged urinary bladder
- Hemi-ovoid smooth mass arising from the pelvis
- Can extend above umbilicus
- Non-mobile and dull to percussion
- Does not bulge into the pelvis
- Can not be felt on rectal examination
Signs of an ovarian cyst
- Smooth mass arising from the pelvis
- Mobile from side-to-side but not up and down
- Dull to percussion
- Palpable fluid thrill
- Lower extremity can be felt on pelvic examination
Causes of hepatomegaly
Smooth generalised enlargement
- Congestion due to cardiac failure
- Micronodular cirrhosis
- Reticuloses
- Hepatic vein obstruction (Budd-Chiari syndrome)
- Infective hepatitis
- Cholangitis
- Portal pyaemia
- Amyloidosis
Knobbly generalised enlargement
- Secondary carcinoma
- Macronodular cirrhosis
- Polycystic disease
Localised swelling
- Riedel's lobe
- Hydatid cyst
- Liver abscess
- Hepatocellular carcinoma
Causes of splenomegaly
Infection
- Bacterial - typhoid, typhus, TB
- Viral - glandular fever
- Protozoal - malaria, kala-azar
Cellular proliferation
- Myeloid and lymphatic leukaemia
- Pernicious anaemia
- Polycythaemia rubra vera
- Spherocytosis
- Thrombocytopenia purpura
- Myelosclerosis
Congestion
- Portal hypertension
- Hepatic vein obstruction
- Congestive heart failure
Others
- Amyloidosis
- Gaucher's disease
- Felty's syndrome
- Angioma
- Lymphosarcoma
Causes of a renal mass
- Hydronephrosis
- Pyonephrosis
- Perinephric abscess
- Hypernephroma
- Nephroblastoma
- Solitary cyst
- Polycystic disease
Causes of a palpable gall bladder
- Obstruction of the cystic duct
- Stone in Hartmann's pouch
- Cholangiocarcinoma
- Obstruction of the common bile duct
- Stone in common bile duct
- Carcinoma of the head of the pancreas
Courvoisier's law
- 'If in the presence of jaundice the gallbladder is palpable, the obstruction of the bile duct causing the
jaundice is unlikely to be due to a stone.'
- Stones causes a thickened non-distensible gall bladder
Causes of a right iliac fossa mass
- Appendicitis
- Tuberculosis
- Carcinoma of the caecum
- Crohn's disease
- Iliac lymphadenopathy
- Psoas abscess
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